The Great Divide: Candidates for Governor Far Apart on Healthcare Issues

Buono's and Christie's differences are likely harbingers of state policy over the coming four years

This is the third in a series of articles exploring the critical policy challenges that the next governor and Legislature will face, as well as their positions on these issues.

The past isn't always prologue to the future, but when it comes to healthcare and the candidates for governor, it could prove prophetic -- at least as far as the next four years are concerned.

From funding to family planning centers to the proposed decriminalization of small amounts of marijuana, Gov. Chris Christie and Sen. Barbara Buono have followed distinctly divergent courses on implementing healthcare policy. And the two candidates' views on the Affordable Care Act have led to sharply contrasting ideas as to how the state should proceed.

Christie has taken a hands-off approach to the ACA’s health insurance marketplace, letting the federal government take the lead, while allowing Medicaid expansion to go forward.

Buono believes that the state should operate its own exchange, enabling it to reap a windfall in federal funding that will let it better inform the public about the law. She thinks the state should embrace the ACA in its totality to make sure it works for New Jerseyans.

The disputes reflect the candidates’ different priorities, with Christie both citing budgetary imperatives that have limited healthcare spending while at times reshaping the state’s approach to healthcare, such as pursuing a comprehensive Medicaid waiver that will shift the focus of long-term care for the elderly and the disabled from institutionalized settings to community-based care.

Christie has left his mark on healthcare policy in other ways, such as moving to merge most of the University of Medicine and Dentistry of New Jersey into Rutgers University.

And he has refused to give ground on criticism that his decisions have been driven by factors other than what is best for residents.

As chairwoman of the Senate Budget Committee from 2008 to 2010 and a current member of the Senate Health, Human Services and Senior Citizens Committee, Buono has also shaped healthcare policy. For one thing she sponsored a bill that requires insurers to cover mammograms for women under 40 with a family history of breast cancer. For another, she sponsored the bond that would have funded stem cell research in the state, which was defeated in a referendum.

Buono said she has been an outspoken advocate for expanding healthcare for low-income residents her entire life and would push to increase funding for women’s health and to expand the reach and lower the cost of health insurance if she’s elected.

The gulf separating Christie and Buono has been evident since the first budget the governor proposed in the spring of 2010, when Christie cut $7.45 million for family planning centers, which contributed to the closing of six family-planning and women’s health centers. The governor first cited budget constraints and later emphasized that the services the centers provided were duplicative.

But Democrats -- including Buono -- and women’s groups believe he cut the funding to burnish his antiabortion credentials and improve his national standing (with an eye to making a bid for a 2016 run for president).

Buono joined with Planned Parenthood and others in arguing that the cuts had a detrimental effect on the centers’ clients .

Christie transferred the funds to the state’s federally qualified health centers. He said the decision eliminated duplicative services without harming access. The Democrats countered by pointing out that the federally qualified health centers serve predominantly low-income clients, while the women’s centers serve everyone. Arguments over the issue have been played for every budget since.